The Perfect Storm, Part II
In the book The Perfect Storm, author Sebastian Junger describes the meteorological conditions that led to the “perfect storm” – a 1991 Halloween Nor’easter that wreaked havoc on the Atlantic seaboard and in which the six-member crew of the Gloucester, Massachusetts-based fishing vessel, the Andrea Gail were lost at sea. The story was dramatically presented in the film version starring George Clooney who played the Andrea Gail’s Captain Billy Tyne. The power of that storm is still being felt across the Atlantic Northeast by those whose loved ones were killed, including the six members of the Andrea Gail’s crew and a rescue diver who died trying to rescue the crew of another ship in distress during the storm.
Ironically, Gloucester, Mass. experienced another perfect storm this summer, though not of the meteorological kind. In May, noticing an increase in the number of students coming to the school clinic for pregnancy tests, Gloucester High School’s nurse practitioner alerted the school’s principal to the issue. What was strange about these visits was not just the increased number of young women coming for tests but the fact they were disappointed when the tests came back negative. In June, the school’s principal stated that he believed a group of students had entered into a “pregnancy pact” and all agreed to get pregnant and have their babies together. The school district’s health coordinator reports that the usual number of pregnant high school students at Gloucester High is about three a year. This year there are 10 students pregnant and planning to have their babies.
Why a “perfect storm” of teen pregnancy at Gloucester High? Several factors contribute. The closest clinic at which school-aged women can obtain birth control without parental consent is in a town 20 miles away. No birth control is offered at the school clinic in Gloucester because, according to clinic staff, the community “will not tolerate it.” Not surprisingly, a school health survey at Gloucester High reports that while condom use is low, sexual activity is high with 68 percent of students reporting being sexually active by their senior year. Middle school students in Gloucester receive sex education and high school freshman are required to take an abstinence-based health class, but the focus of the curriculum is not birth control. After freshman year there is no required sex education course. Budget cutbacks eliminated several physical education classes and health courses at the high school, and those cuts started in the 2000-2001 school year.
The confluence of events – economic, political, social, and behavioral – combined to create a perfect storm at Gloucester High but we all know this could have happened almost anywhere. The factors that lead to 10 young women in Gloucester to get pregnant exist nationwide and we could see similar “storms” in other areas with the same conditions. What is striking about this example is the setting: a high school. We know that students are receptive to health messages delivered at school and in fact schools may be the only places where a child receives comprehensive health education in nutrition, health promotion and prevention, and yes even comprehensive sex education. But far too often health classes are the first to go when budgets are tight, topics are controversial, and broader agendas influence what students should and should not learn.
School health is more than just making sure that someone is there to put a band-aid on a scraped knee during recess, or make sure a child takes their medicine on time during the school-day. In many areas the school nurse could be the sole health provider for a large group of kids, and a school-based clinic may be providing a wide array of primary care services to students, their siblings and their parents. The co-location of community health centers and schools is an interesting model that may encourage access to care for certain populations that may not be able to get services easily anywhere else. Indeed, schools are an excellent place to deliver health interventions: the population is “captive,” the messengers are usually trusted members of the school community, and students can discuss controversial topics with teachers and peers in a setting where asking questions is encouraged.
This issue of Pulse highlights the connections MCH programs are making with schools and educational systems more broadly. The potential for these connections to improve the health of women, children and families is amazing – I just hope that the potential can be realized despite the economic, social and political “storms” that threaten them. The more MCH programs can do with schools, and the communities that support them, the more we truly can do to create the conditions for all to live healthy, productive lives and promote decision-making that encourages making healthy choices.